ANKLE & FOOT
Flatfoot deformities can be very complex to understand, but I am going to break it down and simplify the problem. Flatfeet can first be divided into painful and non-painful flatfeet. If you have a flatfoot and there is no pain, then there is no need to seek treatment. Wear whatever shoe type feels comfortable to you and perform whatever activity or sport that your foot lets you perform. Back in the day, soldiers were excluded from the army if they had flat feet because the thought was that they would be at a disadvantage compared to others. However, this is not the case. A large national study out of Canada decades ago debunked this theory and the evaluation for flatfeet is no longer part of a military fitness competency evaluation.
Now, if your flatfoot is painful, then that is a different story. Painful flatfeet can be divided into flexible and rigid. If you are wondering what type of flatfoot you have, stand on the ground and look at your foot. Now, go up on your toes and look at your feet again. If they stay in the exact same position, then they are rigid. If the arch starts to come up (even a little) then it is flexible. In the initial treatment of painful flatfeet. To better understand the treatment of flatfeet it is important to understand why it’s becoming painful.
The pathology behind the development of flatfeet has to do with injury or inflammation of the posterior tibial tendon. This tendon originates in the calf, travels around the inside of the ankle (medial malleolus) and attaches to the midfoot (navicular bone) where it helps to dynamically pull the arch into position. When this tendon becomes dysfunctional, the arch starts to drop, and the foot starts to collapse into a valgus or pronated position. Initial treatment to remedy this focuses on supporting the arch with an orthotic (insole for the shoe, custom or OTC) and physical therapy to calm down inflammation around the posterior tibial tendon and rebuild strength. For most people with early onset painful flatfoot deformity, this can be very effective. For those patients that this is not effective for, further work up and treatment is necessary. More supportive walking boots and customized braces can be utilized to allow the tendon to recover. When this is ineffective, advanced imaging with MRI is used to rule out tearing of this tendon.
When the non-surgical treatments for painful flatfeet fail, surgery becomes an option. The range of options is dictated by whether the flatfoot is flexible or rigid. Surgical options range from tendon repairs, transfers and corrective osteotomies to fusions and replacements depending on how advanced the disease process is. But let me tell you, recovery from surgery is no walk in the park. Reconstructive surgery usually requires 6 weeks of non-weight bearing in a cast, followed by 6 weeks in a walking boot, and takes upwards of 12-18 months to be 100%. While the recovery is arduous, it can be incredibly helpful and rewarding as patients get back their quality of life.
